Objectives : To evaluate the internal burden and hazardous effects associated with smoking in middle and high school students. Methods : We analysed urinary cotinine(U-cotinine) concentrations and the frequency of Sister Chromatid Exchanges (SCE). A comparison was done of U-cotinine concentrations and the frequency of SCE in peripheral lymphocytes across school levels (middle vs. high) and smoking types (direct: daily & occasional smoking, indirect; usual indirect & non-smoking), in 122 males. Results : The middle school student group comprised 6.8% daily smokers, 15.9% occasional smokers, 40.9% daily indirect smokers, and 35.4% nonsmokers, while the high school student group comprised 18.0%, 20.5%, 35.7%, and 21.8%, respectively. The U-cotinine concentration and the frequency of SCE among the middle school students were $79.11{mu}g/l$ and 2.0 per cell, respectively, which were significantly lower than the $146.85{mu}g/l$ (p=0.078) and 2.6 per cell (p=0.005) of the high school students. Among the 40 direct smokers, these two biomarkers were $236.66{mu}g/l$ and 2.59 per cell, significantly higher than the $67.33{mu}g/l$ (p=0.0001) and 2.1 per cell (p=0.003) among indirect smoking groups. The variation in individual U-cotinine concentration ranged widely in both the indirect and direct smoking groups. Conclusion : Urinary cotinine concentrations and the frequency of Sister Chromatid Exchange seem to objectively and effectively evaluate student exposure whether it was direct or indirect smoking. Consequently, these biomarkers may be useful in monitoring the objective efficacy of anti-smoking programs in adolescent populations.